- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,615.00 / $1,821.79 / $7,439.00
| Facility | | $1,615.00 | $1,821.79 | $7,439.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $13,652.00
| Facility | | $606.10 | $606.10 | $13,652.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,821.79 / $2,294.44 / $3,626.85
| Facility | | $1,821.79 | $2,294.44 | $3,626.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,153.00 / $21,463.00 / $29,047.00
| Facility | | $8,153.00 | $21,463.00 | $29,047.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $19,180.98 / $19,180.98
| Facility | | $5,000.00 | $19,180.98 | $19,180.98 |